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Abstract:

One provides (101) a plurality of different treatment plans for a given
patient, wherein at least one such plans is provided by using deformation
information that is obtained by using historical information for persons
other than the given patient regarding physical changes over time as
correspond to at least one volume within the given patient and/or
calculated information regarding physical changes as correspond to the at
least one volume within the patient. Obtained data (102) as pertains to
the patient is then used to select (103) a particular one of the
aforementioned plurality of different treatment plans.

Claims:

1. A method to facilitate generating a treatment plan for irradiating a
treatment volume within a patient, comprising: providing a plurality of
different treatment plans for the patient wherein at least one of the
plurality of different treatment plans is provided by using deformation
information that is obtained by at least one of: using historical
information for persons other than the patient regarding physical changes
over time as correspond to at least one volume within the patient; and
using calculated information regarding physical changes as correspond to
the at least one volume within the patient; obtaining data as pertains to
the patient; selecting a particular one of the plurality of different
treatment plans as a function, as least in part, of the data as pertains
to the patient to provide a selected treatment plan; using the selected
treatment plan when irradiating the treatment volume within the patient.

Description:

CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application is a continuation of U.S. patent application Ser.
No. 12/389,051, filed Feb. 19, 2009 entitled Method And Apparatus To
Facilitate Generating A Treatment Plan For Irradiating A Patient's
Treatment Volume, which is incorporated by reference in its entirety
herein.

[0007] Radiation therapy techniques are known. Generally speaking, a
trained person such as a radiologist treats a patient having undesired
tissue (such as a tumor) by irradiating the undesired tissue in order to
reduce or eradicate that undesired tissue. As such treatment can also
damage or destroy healthy tissue, such radiation is typically
administered in accordance with a corresponding plan. The goal of such a
plan is usually to control the shape, strength, timing, and other
characterizing attributes of the radiation beam (or beams) to limit the
effects of the radiation to only the undesired tissue.

[0008] The development of such a plan comprises a complicated and often
dynamic undertaking. Such a plan will ordinarily need to account for both
the general geometries and characteristics of a given radiation platform
as well as the unique attributes or capabilities of a given specific
radiation platform to be employed in a given treatment scenario. Such a
plan will also often heavily depend upon information regarding the
undesired tissue itself as well as desired tissue in the treatment
volume. This can include, for example, information concerning the
treatment volume itself (such as the size and shape of the treatment
volume) as well as relative positioning of that treatment volume with
respect to other adjacent desired tissue.

[0009] As radiation therapy often plays out in numerous treatment sessions
over an extended period of time, yet another related complication can
arise; changes over time with respect to the absolute and relative
locations of the undesired and desired tissues and/or changes to their
relative geometry. Such changes can be owing, for example, to differences
in elasticity of the various materials involved (for example, as they
react to various stimuli such as the relative fullness or emptiness of a
nearby organ such as the bladder), shrinkage (or growth) of these
materials, and so forth.

[0010] Such changes are problematic because they create at any given
moment a need for a treatment plan that is likely different than a
treatment plan that was previously used with a given patient. The
time-consuming nature of forming and approving such a plan to accommodate
such changes, however, is highly inconsistent with the temporal needs of
the patient and the treatment facility itself in most cases. Furthermore,
such plans typically require the approval of one or more expert
practitioners who are often not immediately available to offer their
approvals on a schedule that matches the dynamic requirements of such a
treatment facility.

BRIEF DESCRIPTION OF THE DRAWINGS

[0011] The above needs are at least partially met through provision of the
method and apparatus to facilitate generating a treatment plan for
irradiating a patient's treatment volume described in the following
detailed description, particularly when studied in conjunction with the
drawings, wherein:

[0012] FIG. 1 comprises a flow diagram as configured in accordance with
various embodiments of the invention;

[0013] FIG. 2 comprises a schematic view as configured in accordance with
various embodiments of the invention; and

[0014] FIG. 3 comprises a block diagram as configured in accordance with
various embodiments of the invention.

[0015] Skilled artisans will appreciate that elements in the figures are
illustrated for simplicity and clarity and have not necessarily been
drawn to scale. For example, the dimensions and/or relative positioning
of some of the elements in the figures may be exaggerated relative to
other elements to help to improve understanding of various embodiments of
the present invention. Also, common but well-understood elements that are
useful or necessary in a commercially feasible embodiment are often not
depicted in order to facilitate a less obstructed view of these various
embodiments of the present invention. It will further be appreciated that
certain actions and/or steps may be described or depicted in a particular
order of occurrence while those skilled in the art will understand that
such specificity with respect to sequence is not actually required. It
will also be understood that the terms and expressions used herein have
the ordinary technical meaning as is accorded to such terms and
expressions by persons skilled in the technical field as set forth above
except where different specific meanings have otherwise been set forth
herein.

DETAILED DESCRIPTION

[0016] Generally speaking, these various embodiments serve to facilitate
the generation of a treatment plan (or plans) for irradiating a treatment
volume within a patient. As used herein, it will be understood that this
expression "treatment volume" refers to an area, typically but not
necessarily fully subsumed within a patient's body, that may include (in
whole or in part) one or more organs, tissues, glands, or the like where
typically some of the included material comprises desired material and
some of the included material comprises undesired material (where the
latter usually comprises the target of the irradiation treatment).

[0017] Pursuant to these teachings, one provides a plurality of different
treatment plans for a given patient. At least one of these treatment
plans is provided by using deformation information that can be applied to
modify an original diagnostic image as pertains to the treatment volume.
The deformation information can comprise, for example, information
regarding anticipated changes over time as are likely to apply with
respect to the patient in question. By one approach one obtains this
deformation information by using historical information for persons other
than the given patient regarding physical changes over time as correspond
to at least one volume within the given patient. This one volume, for
example, can be identical to, or at least overlap in some respects with,
the aforementioned treatment volume. This historical information can
comprise, for example, information regarding changes to geometry as
pertain to the at least one volume within the patient and/or information
regarding movement of specific objects within that treatment volume.

[0018] By another approach, used in combination with the historical
information described above or in lieu thereof, one obtains this
deformation information by using calculated information regarding
physical changes as correspond to the at least one volume within the
patient. For example, this calculated information can comprise
calculations based upon elasticity information for at least one object
within the treatment volume. As another example in these regards, a
clinical expert (or experts) might provide possible movement data for a
limited set of points within the patient and other points within the
patient could then be moved according to calculations that are based upon
a corresponding elasticity model.

[0019] These teachings then provide generally for obtaining data as
pertains to the patient and then selecting a particular one of the
aforementioned plurality of different treatment plans as a function, at
least in part, of this patient data. By one approach, for example, this
can comprise selecting a particular one of the plurality of different
treatment plans as corresponds to the modified image (that was formed
through modification of an original diagnostic image as pertains to the
treatment volume using the aforementioned deformation information) having
at least one metric that correlates most closely to a corresponding
metric in the data as pertains to the patient.

[0020] These teachings will then accommodate using the selected treatment
plan when irradiating the treatment volume within the patient.

[0021] Those skilled in the art will appreciate that the step of providing
the plurality of different treatment plans for a given patient can be
undertaken well prior to the step of selecting a particular one of the
plurality of treatment plans to be employed in a given treatment session.
For example, at least some of these different treatment plans can be
formed hours, days, or even weeks (or more) prior to the patient visiting
the treatment facility for the administration of the selected plan. This
means, of course, that the time requirements to formulate such plans, and
gaining the approval of such treatment plans from skilled and authorized
persons, can be readily accommodated in a way that is fully compatible
with the time requirements of the treatment facility and the patient.
Those skilled in the art will also recognize, of course, that these
teachings can also be employed in a more immediate context (as when, for
example, the patient is prepped and awaiting treatment).

[0022] These and other benefits accrue, at least in substantial part, to
the use of the aforementioned historical and/or calculated information.
In particular, the use of such information permits useful and
likely-valid treatment plans to be developed for a given patient that
account for likely physical alterations within that patient's treatment
volume.

[0023] These and other benefits may become clearer upon making a thorough
review and study of the following detailed description. Referring now to
the drawings, and in particular to FIG. 1, an illustrative process that
is compatible with many of these teachings will now be presented. As
alluded to earlier, this process 100 serves to facilitate generating a
treatment plan for irradiating a treatment volume within a patient.

[0024] This process 100 includes the step 101 of providing a plurality of
different treatment plans for the patient. By one approach, this can
comprise generating one or more of these different treatment plans in
conjunction with the patient's visit to the treatment facility to receive
a corresponding radiation treatment. By another (perhaps more useful and
likely) approach, some or all of these treatment plans are generated well
prior to a present need to select and implement such a plan. This can
mean, for example, generating these plans days, weeks, or possibly even
months prior to an immediate need for the availability of such plans.

[0025] This step 101 can comprise providing at least one of these
different treatment plans by using deformation information obtained via
at least one of two possible general approaches. By a first such
approach, this can comprise using historical information for persons
other than the patient. This historical information can itself comprise
information regarding physical changes over time as correspond to at
least one volume within the patient. In a typical application setting,
this volume will coincide, at least in part, with the patient's
anticipated or planned treatment volume. Those skilled in the art will
recognize that at least some such physical changes are, for all intents
and purposes, random changes. Accordingly, it will generally not be
possible to accurately predict with certainty a particular
all-encompassing view of the treatment volume.

[0026] One example in this regard would be information regarding changes
to geometry as pertain to at least one volume within the patient. This
can comprise, for example, a previously-treated treatment target that is
expected to shrink in size during the course of treatment.

[0027] Another example of potentially useful historical information would
be information regarding the movement of specific objects within the
treatment volume. This can comprise, for example, an object such as a
prostate gland that will move as the patient's bladder experiences
different states of fullness.

[0028] As noted, this historical information includes information
empirically developed from persons other than the patient. This does not
preclude also using relevant historical information for this patient when
and as available, but in a typical application setting such a fortuitous
circumstance will usually be the exception rather than the rule. This
historical information can be gleaned from any of a variety of sources
including but not limited to medical studies and research of various
kinds. This historical information can be as general, or as specific, as
may be desired and/or as the source content may permit. For example, when
and as appropriate, this historical information can be limited to
information derived from persons having the same gender, age, height,
weight, genetic predispositions, and/or the like as the patient.

[0029] By a second such approach, the deformation information for one or
more of these different treatment plans can be obtained by using
calculated information regarding physical changes as correspond to the at
least one volume within the patient. Such calculations can be based upon
any of a variety of potential parameters of interest. As one example in
these regards, these calculations can be based upon elasticity
information for at least one object within the treatment volume.

[0030] As used herein, this reference to "elasticity" should be taken
broadly. By one approach, for example, this can refer to physical
elasticity. For example, some objects in the body, such as the walls of
the bladder, are considerably more physically elastic than other objects
in the body, such as bone. Mathematically-modeled representations of such
objects can serve to yield the aforementioned deformation information. By
one approach, such elasticity can be accounted for via use of one or more
corresponding elasticity models (where, for example, some or all of the
contents of the elasticity model are calculated using Hounsfield unit
values as derived from one or more patient images).

[0031] By another example, this reference to elasticity can be understood
to refer to biological elasticity. A simple example of biological
elasticity is that the amount of various gases, liquids, and/or solids
present in various parts of the body (such as, for example, the amount of
liquid material in a bladder, the amount of material in the digestive
tract, the amount of air in the lungs, and so forth) can change over
time. Another simple example of biological elasticity is sliding
interfaces between various objects in the volume of interest. Those
skilled in the art will recognize that such objects can comprise any of a
variety of organs and other anatomical structures. As one non-limiting
example of a sliding interface of interest is the ability of one organ or
other structure to slide past another by translating in addition to
rotating with respect to one another.

[0032] As noted, one or more of the aforementioned treatment plans can be
provided by using deformation information that is itself obtained using
such historical and/or calculated information. These teachings will
readily accommodate a great number of permutations and combinations in
these regards. For example, by one approach, only one of the treatment
plans might be based only upon historical information with the remaining
treatment plans having a different origin. As another example, only one
of these treatment plans might be based only upon calculated information
with the remaining treatment plans again having an origin other than via
such historical or calculated information. As another example in these
regards, one of the treatment plans may be derived from historical
information, another of the treatment plans may be derived from
calculated information, and all of the remaining plans based upon a
different origin.

[0033] These teachings will also accommodate having a greater number of
treatment plans based upon such information sources. For example, two (or
more) of the treatment plans can be based upon historical information (or
calculated information), up to and including all of the treatment plans.
These teachings will also accommodate having some plans (from one to
nearly all) based upon the historical information and some plans (from
one to nearly all) based upon the calculated information.

[0034] Those skilled in the art will also appreciate that these teachings
will further accommodate providing one or more treatment plans that are
each based both upon the historical information and the calculated
information.

[0035] By one approach, this step 101 of providing these differing
treatment plans can include using the aforementioned deformation
information to modify an original diagnostic image as pertains to the
treatment volume to thereby provide at least one modified image. (As used
herein, this reference to "original" will be understood to refer to a
previously captured diagnostic image, such as an X-ray image, a CAT scan
image, an MRI image, and so forth for the patient. This image may, or may
not, be a first such image for this particular patient.)

[0036] Referring momentarily to FIG. 2, and by way of illustration and
without intending any limitations in these regards, an original
diagnostic image 201 can include a first object 202 and a second object
203 that are both within the treatment volume of the patient. Using
deformation information gleaned from the aforementioned historical
information and/or calculated information, this original image 201 is
modified in this example to provide a modified image 204 where the
aforementioned second object 203 no longer has a same location or size
(as denoted by the phantom line object denoted by reference numeral 203A)
but has instead shrunken to a smaller size and moved to a different
location as denoted by reference numeral 203B.

[0037] Those skilled in the art will understand that this modified image
204 is not wholly based upon current empirical information for the
patient. Instead, an original image 201 for this patient is modified to
incorporate historically-based and/or calculation-based deformation
information. This modified image 204 may, or may not, conform closely to
the patient's actual presentation at the time of treatment. Being based
upon a reliable historical and/or calculated foundation, however, this
modified image 204 presents a reasonable possibility in these regards.

[0038] It will therefore be understood that, in a typical application
setting, these teachings will comprise providing a variety of different
modified images that each present a possible scenario for how the patient
will actual present himself or herself at the time of treatment. The
number of such candidate images provided in a given instance can vary
with the needs and/or opportunities as tend to characterize a given
application setting. In some cases, for example, five to ten such
modified images may suffice to adequately represent a useful range of
possibilities for a given patient. In other cases, it may be more
appropriate to provide twenty, thirty, or more such modified images while
in yet other cases it may be adequate to simply provide for only one or
two such modified images.

[0039] This step 101 of providing a plurality of different treatment plans
can comprise developing a treatment plan that is specific and appropriate
to each of these candidate modified images. These treatment plans can
vary from one another, for example, with respect to various treatment
equipment settings such as radiation intensity, time of exposure,
directionality, and so forth. Each such plan can be fully developed using
whatever plan-development process a given practitioner may prefer.

[0040] Each such plan can further be vetted and approved by such persons
and via whatever authorization process a given service provider may deem
necessary. Those skilled in the art will appreciate that the time
requirements inherent to such activities are largely without adverse
consequence to maintaining an ability to receive, treat, and dismiss a
given patient in an efficient and timely manner because these activities
can all be undertaken and concluded well in advance of a present need to
implement a particular treatment plan for the patient.

[0041] Referring again to FIG. 1, this process 100 then provides for the
step 102 of obtaining data as pertains to the patient. In a typical
application setting this will comprise obtaining this information at a
time that is just prior to administering the corresponding radiation
treatment. As one non-limiting example in this regard, this patient data
can be obtained within one hour of when the treatment is to be
administered.

[0042] The precise nature of this data can of course vary with respect to
the application setting, the patient, the nature of the treatment itself,
and the native capabilities of the treatment facility. Generally
speaking, however, in many cases this data can comprise image data that
corresponds to the patient's treatment volume. Examples include, but are
not limited to, x-ray images, computed tomography (CT) images, magnetic
resonance imaging (MRI) images, ultrasound images, and so forth. In many
cases this data can be captured, in the first instance, in a digital
form. Those skilled in the art will recognize and appreciate that the
following steps can also be carried out in a digital realm, hence
leveraging the value of capturing the patient data in a digital form.

[0043] This process 100 then provides the step 103 of selecting a
particular one of the aforementioned plurality of different treatment
plans as a function, at least in part, of the aforementioned patient data
to thereby provide a selected treatment plan. By one approach, for
example, this can comprise selecting a particular one of the plurality of
different treatment plans as corresponds to a given one of the
aforementioned modified images that best matches an image as corresponds
to aforementioned patient data. Such an approach can comprise, for
example, identifying the modified image having at least one metric that
correlates most closely to a corresponding metric in the data as pertains
to the patient. Such a metric can comprise, for example, a location of
the center of the tissue to be treated, a diameter or peripheral
measurement for the tissue to be treated, a given distance from a center
of the tissue to be treated from some other point of reference, a given
distance as pertains to one or more marker seeds as were previously
implanted within the treatment volume, an angle of rotation of an organ
or structure, a volume of the contents contained within a given organ, a
volume or other dimension of a given target object, and so forth. By way
of further example (but not by way of limitation), this metric can
comprise a metric regarding at least one of a change in tumor size, a
change in organ volume, a change in patient weight, a change in patient
structure position (where "structure" will be understood to comprise an
organ or other body as comprises a physical part (including both
biological (including various tissues, bones, and so forth) and
non-biological parts) of the patient), a rotation of a patient structure,
and a translation of a patient structure.

[0044] In many cases, of course, it will be useful to identify a
particular modified image as best matching the patient's present data by
referencing more than one such metric. By one approach, one or more
computer-implemented pattern-matching algorithms of choice can be
employed to perform, in whole or in part, this step 103. There are
numerous such algorithms known in the art. This step 103 can also employ,
in combination with the above or in lieu thereof, the use of implanted
seeds as a basis for measurements of value in selecting a particular
plan.

[0045] It will be further appreciated that this step 103 can also comprise
selecting the particular one of the plurality of different treatment
plans to use when treating the patient as a function, at least in part,
of both the data as pertains to the patient as well as information
regarding results of at least one previous treatment of the treatment
volume. This might comprise, for example, using clinical test results
from which one can estimate a relative size or position of a given object
within the treatment volume. Such clinical test results might comprise,
for example, certain blood test results or the like.

[0046] This process 100 then provides the follow-on step 104 of using the
selected treatment plan when irradiating the treatment volume within the
patient. This can of course comprise automatically or manually setting
one or more operational settings for the treatment platform and/or
physically positioning the patient in a particular way to comport with
the specifications of the selected treatment plan.

[0047] Those skilled in the art will appreciate that the above-described
processes are readily enabled using any of a wide variety of available
and/or readily configured platforms, including partially or wholly
programmable platforms as are known in the art or dedicated purpose
platforms as may be desired for some applications. Referring now to FIG.
3, an illustrative approach to such a platform will now be provided.

[0048] In this illustrative example, an apparatus 300 to facilitate
generating a treatment plan for irradiating a treatment volume within a
patient comprises a processor 301 that operably couples to a first memory
302, a second memory 303, and a third memory 304. Those skilled in the
art will recognize and appreciate that such a processor 301 can comprise
a fixed-purpose hard-wired platform or can comprise a partially or wholly
programmable platform. All of these architectural options are well known
and understood in the art and require no further description here.

[0049] The first memory 302 can have stored therein the aforementioned
plurality of different treatment plans for the patient. It will be
recalled that at least one of these treatment plans is provided through
use of deformation information that is obtained through use of historical
information for persons other than the patient, calculated information
regarding physical changes as correspond to at least one volume within
the patient, or both. The second memory 303 can have stored therein the
aforementioned data as pertains to the patient. The third memory 304 can
have stored therein the aforementioned original diagnostic image as
pertains to the treatment volume. It will be understood that the memory
components shown can comprise a plurality of memory elements (as is
suggested by the illustration) or can be comprised of a single memory
element. It will also be understood that these memory components can be
local to the processor 301 or can be remotely located and accessed via an
intervening network such as a local area network (LAN), the Internet, or
the like.

[0050] The processor 301 can be configured (using, for example,
corresponding programming as will be well understood by those skilled in
the art) to carry out one or more of the steps, actions, or functionality
set forth herein. This can comprise, for example, configuring the
processor 301 to use the deformation information to modify the original
diagnostic image as pertains to the treatment volume to thereby provide
at least one corresponding modified image. This can further comprise, for
example, using a user interface (not shown) to permit a user to select a
particular one of the plurality of different treatment plans as
corresponds to a modified image having at least one metric that
correlates most closely to a corresponding metric in the data as pertains
to the patient. In the alternative, the processor 301 can be configured
to automatically make this determination itself. As yet another
alternative, the processor 301 can be configured to identify one (or
more) candidate modified images as best matching the patient's current
data and to present that candidate modified image (or images) to a user
of the apparatus 300 to gain their final selection and/or approval of the
selection.

[0051] If desired, the details regarding this selection can then be
passed, automatically or in response to an end user's instruction, to the
treatment platform 305. This can comprise, by one approach, having the
processor 301 automatically adjust one or more of the operating settings
of the treatment platform. This can include, for example, setting
radiation intensity levels, exposure durations, pulse rates, field
shapes, energy, lateral intensity distribution, and so forth to match the
specifications of the selected treatment plan.

[0052] Those skilled in the art will recognize and understand that such an
apparatus 300 may be comprised of a plurality of physically distinct
elements as is suggested by the illustration shown in FIG. 3. It is also
possible, however, to view this illustration as comprising a logical
view, in which case one or more of these elements can be enabled and
realized via a shared platform. It would be possible, for example, to
integrate the described functionality with the treatment platform 305
itself. It will also be understood that such a shared platform may
comprise a wholly or at least partially programmable platform as are
known in the art.

[0053] So configured, patients can be received and treated in a relatively
short period of time in a manner that does not require an immediate and
on-site presence of expert practitioners having the requisite knowledge,
experience, and authorization to select a particular treatment plan for a
given patient. Notwithstanding this high level of temporal efficiency,
these teachings also tend to encourage and permit a high degree of
personal customization of a treatment plan for a given patient. It will
be appreciated that these teachings are highly compatible with existing
treatment platforms and decision-making processes and hence are keenly
capable of greatly leveraging such existing approaches. It will be
further appreciated that these teachings are highly scalable and are
suitable for use in a wide variety of application settings involving a
wide variety of treatments, patients, and treatment volumes.

[0054] Those skilled in the art will also appreciate that these teachings
can be applied to accommodate yet another category of clinical
variations--day-to-day variations with respect to the patient's position
and pose during the treatment process itself. Changes with respect to
articulation of skeletal anatomy, for example, can produce significant
changes to other body materials. Rotation of bony joints, for example,
can and will distort affected soft tissues (consider, for example, that
the angle of the two femurs in the pelvic girdle can and will cause
significant distortion of the soft tissue anatomy in the pelvis). As
another example in these regards, a simple rotation of the patient's head
within a face mask will result in a shift in the location of the base of
the skull; this, in turn, results in a shift of the curvature in the
cervical spine. At least one or more of the various treatment plans of
these teachings can be designed and selected to accommodate such
variations with respect to the pose-based presentation of the patient to
thereby further ease the patient's burden in these regards while
nevertheless tending to assure the desired treatment of the patient's
condition.

[0055] Those skilled in the art will recognize that a wide variety of
modifications, alterations, and combinations can be made with respect to
the above described embodiments without departing from the spirit and
scope of the invention, and that such modifications, alterations, and
combinations are to be viewed as being within the ambit of the inventive
concept. As one example in these regards, these teachings will readily
accommodate providing a plurality of treatment strategies that each
represent some allowable random variations in the patient (as may relate,
for example, to the variable fullness of the patient's bladder and so
forth), which variations are applied to a baseline plan to yield the
aforementioned treatment plans. As another example in these regards,
these teachings will also readily accommodate anticipated and articulated
drift in such a baseline plan (as may be appropriate in application
settings where, for example, the clinical response to treatment over time
can include a rapid change in size (as when tumors, such as certain
tumors in the head or neck region may respond quickly to therapy by
rapidly shrinking over time) or where healthy organs-at-risk are likely
to move into a high dose region and become exposed to that corresponding
risk). And it would also of course be possible to combine the use of a
shifting baseline plan with the aforementioned variations-based
modifications to a given baseline.